Insurers to Comply With Rules on Children

ROBERT PEAR

Wednesday

Mar 31, 2010 at 5:16 AM

Under pressure from the White House, insurance companies said they would cover children with pre-existing conditions.

WASHINGTON — Under pressure from the White House, health insurance companies said Tuesday that they would comply with rules to be issued soon by the Obama administration requiring them to cover children with pre-existing medical problems.

“Health plans recognize the significant hardship that a family faces when they are unable to obtain coverage for a child with a pre-existing condition,” said Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group. Accordingly, she said, “we await and will fully comply with” the rules.

Ms. Ignagni made the commitment in a letter to Kathleen Sebelius, the secretary of health and human services, who had said she feared that some insurers might exploit a possible ambiguity in the new health care law to deny coverage to some sick children.

The White House immediately claimed victory.

In a Twitter message, Robert Gibbs, the White House press secretary, scored the tug of war as “Kids 1, insurance 0.”

Major provisions of the law take effect in 2014. Some, including a ban on “pre-existing condition exclusions” for children under 19, take effect in September. The law does not explicitly say that insurers must sell insurance to families with such children this year, but Democratic Congressional leaders and White House officials said that was their intent.

To eliminate any ambiguity, Ms. Sebelius said, she will issue rules defining the scope of the new law.

Under these rules, Ms. Sebelius said, “children with pre-existing conditions may not be denied access to their parents’ health insurance plan,” and “insurance companies will no longer be allowed to insure a child but exclude treatments for that child’s pre-existing condition.”

In response to a question, Nick Papas, a spokesman for the Department of Health and Human Services, said the rules would require insurers to offer coverage to children with pre-existing conditions, including those who have never had health insurance.

Ms. Sebelius said she was pleased that “insurance companies plan to do the right thing.”

It was not immediately clear whether the rules would allow insurers to charge higher premiums to families with children with pre-existing conditions. Administration officials said they would be monitoring any rate increases.

Some Democrats in Congress want Mr. Obama to take a tough line. If insurers could raise premiums without limits, they would, in effect, be denying coverage, Democrats say.

Some insurers said they were unclear about the language of the law, based on differing accounts, and looked forward to detailed guidance from the government.

“There has been some confusion regarding the elimination of pre-existing condition evaluation for children in the health care bill,” said Kristin E. Binns, a spokeswoman for WellPoint, one of the largest insurers. She said the company would “follow the law on this and all matters.”

Insurers said they would accept the administration’s reading of the law, even if they did not fully agree with it, because they wanted to avoid a showdown over the politically explosive issue of health insurance for sick children.

Several lawyers said Congress could easily clear up any confusion by revising the law. “The real solution here is a legislative fix so all players in the industry can act according to a clear set of rules,” said William G. Schiffbauer, a Washington lawyer whose clients include employers and insurance companies.

Representative Allyson Y. Schwartz, Democrat of Pennsylvania, who helped write a similar provision in an earlier version of the legislation, said the new law “requires that all insurers issue insurance to children regardless of health status, and cover all of their ailments,” starting in September.

Jeff Smokler, a spokesman for the Blue Cross and Blue Shield Association, said its member companies were “fully committed to complying with the new law” and accepted the principles set forth by Ms. Sebelius.

Gail K. Boudreaux, executive vice president of the UnitedHealth Group, said she supported the administration’s effort to clarify the law “to ensure that no child will be denied access to health insurance because of a pre-existing condition.”

“We expect that the new regulations will eliminate any uncertainty about the law’s intent,” Ms. Boudreaux said.

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